IJCM  Vol.11 No.7 , July 2020
Rhomboid Flap vs. Keystone Perforator Island Flap (KPIF) in the Treatment of Pilonidal Sinus Disease: Comparison of Short-Term Results
Abstract: Background: Pilonidal disease is a chronic inflammatory disease of the sacrococcygeal region that mainly affects young people. Its incidence is 26 cases per 100,000 persons. Although many techniques have been described, there is no consensus on the treatment of pilonidal sinus disease (PSD). Materials and Methods: This study included 30 patients with PSD who were treated between May 2014 and September 2017. All cases underwent excision and flap reconstruction. The operative time, postoperative complications, the length of hospital stay, painless sitting and walking time, patient satisfaction and recurrence were evaluated prospectively. Results: The results of this prospective, randomized and comparative study are based on experience of a single surgical centre. All patients were followed up 18 months after discharge from the hospital. There is a difference in surgery durations (minutes) between the two groups (33.86 ± 2.89 min. in “keystone” flap vs. 41.26 ± 4.19 in the “rhombic” flap group) (p = 0.001). There were no significant differences in the length of hospital stay, painless sitting and walking time or patient satisfaction. The total complication rate was 66.6% after rhomboid flap compared with 6.6% after keystone flap. There was no flap necrosis. Conclusions: Both of these methods have shown to be successful in treatment of PSD. The KPIF is associated with the advantages of very simple design, abundant blood supply from the perforator vessels and lower rate of complication.
Cite this paper: Roatis, M. and Georgescu, A. (2020) Rhomboid Flap vs. Keystone Perforator Island Flap (KPIF) in the Treatment of Pilonidal Sinus Disease: Comparison of Short-Term Results. International Journal of Clinical Medicine, 11, 454-464. doi: 10.4236/ijcm.2020.117038.

[1]   Saydam, M., Ozturk, B., Sinan, H., Balta, A. Z., Demir, P., Ozer, M.T. and Demirbas, S. (2015) Comparison of Modified Limberg Flap Transposition and Lateral Advancement Flap Transposition with Burow’s Triangle in the Treatment of Pilonidal Sinus Disease. The American Journal of Surgery, 210, 772-777.

[2]   Rashidian, N., Vahedian-Ardakani, J., Baghai-Wadji, M., Keramati, M.R., Saraee, A., Ansari, K. and Adman, A.A. (2014) How to Repair the Surgical Defect after Excision of Sacrococcygeal Pilonidal Sinus: A Dilemma. Journal of Wound Care, 23, 630-633.

[3]   Horwood, J., Hanratty, D., Chandran, P. and Billings, P. (2012) Primary Closure or Rhomboid Excision and Limberg Flap for the Management of Primary Sacrococcygeal Pilonidal Disease? A Meta-Analysis of Randomized Controlled Trials. Colorectal Disease, 14, 143-151.

[4]   Eastment, J. and Slater, K. (2020) Outcomes of Minimally Invasive Endoscopic Pilonidal Sinus Surgery. Asian Journal of Endoscopic Surgery, 13, 324-328.

[5]   Bali, İ., Aziret, M., Sözen, S., Emir, S., Erdem, H., Ģetinkünar, S. and İrkörücü, O. (2015) Effectiveness of Limberg andkarydakis Flap in Recurrent Pilonidal Sinus Disease. Clinics (Sao Paulo), 70, 350-355.

[6]   Ates, M., Dirican, A., Sarac, M., Aslan, A. and Colak, C. (2011) Short and Long-Term Results of the Karydakis Flap versus the Limberg Flap for Treating Pilonidal Sinus Disease: A Prospective Randomized Study. The American Journal of Surgery, 202, 568-573.

[7]   Behan, F.C. (2003) The Keystone Design Perforator Island Flap in Reconstructive Surgery. ANZ Journal of Surgery, 73, 112-120.

[8]   Mohan, A.T., Rammos, C.K., Akhavan, A.A., Martinez, J., Wu, P.S., Moran, S.L., et al. (2016) Evolving Concepts of Keystone Perforator Island Flaps (KPIF): Principles of Perforator Anatomy, Design Modifications, and Extended Clinical Applications Plastic and Reconstructive Surgery, 137, 1909-1920.

[9]   Wu, M.L., Sun, M.Y., Dai, H.Y., Xu, J.G., Wang, X.W., Guo, R., Wang, Y.C. and Xue, C.Y. (2019) The Application of Keystone Flap Combined with Vacuum-Assisted Closure in the Repair of Sacrococcygeal Skin Defect after Tumor Resection. Journal of Surgical Oncology, 119, 974-978.

[10]   Federico, T., Mario, C., Stefano, S., Claudia, F. and Luigi, V. (2012) A Modified Rhomboid Flap: The “Diamond Flap”. Dermatologic Surgery, 38, 1851-1855.

[11]   Turan, T., Kuran, I., Ozcan, H. and BaŞ, L. (1999) Geometric Limit of Multiple Local Limberg Flaps: A Flap Design. Plastic and Reconstructive Surgery, 104, 1675-1678.

[12]   Lister, G.D. and Gibson, T. (1972) Closure of Rhomboid Skin Defects: The Flaps of Limberg and Dufourmentel. British Journal of Plastic Surgery, 25, 300-314.

[13]   Mahdy, T. (2008) Surgical Treatment of the Pilonidal Disease: Primary Closure or Flap Reconstruction after Excision. Diseases of the Colon & Rectum, 51, 1816-1822.

[14]   De Parades, V., Bouchard, D., Janier, M. and Berger, A. (2013) Pilonidal Sinus Disease. Journal of Visceral Surgery, 150, 237-247.

[15]   Sahebally, S.M., Mcmahon, G., Walsh, S.R. and Burke, J.P. (2018) PWE-018 Classical Limberg versus Karydakis Flaps for Pilonidal Disease—A Meta-Analysis of Randomised Controlled Trials. Gut 2017, 66, A134.

[16]   Yildiz, T., Ilce, Z. and Kücük, A. (2014) Modified Limberg Flap Technique in the Treatment of Pilonidal Sinus Disease in Teenagers. Journal of Pediatric Surgery, 49, 1610-1613.

[17]   Venus, M. and Titley, O. (2012) Outcomes in the Repair of Pilonidal Sinus Disease Excision Wounds Using a Parasacral Perforator Flap. The Annals of the Royal College of Surgeons of England, 94, 12-16.

[18]   Arpaci, E., Altun, S., Orhan, E., Eyuboglu, A. and Ertas, N.M. (2018) A New Oval Advancement Flap Design for Reconstruction of Pilonidal Sinus Defect. World Journal of Surgery, 42, 3568-3574.

[19]   Yoon, C.S., Kim, H.B., Kim, Y.K., Kim, H. and Kim, K.N. (2019) Keystone-Design Perforator Island Flaps for the Management of Complicated Epidermoid Cysts on the Back. Scientific Reports, 9, Article No. 14699.

[20]   Koshima, I., Moriguchi, T., Soeda, S., et al. (1993) The Gluteal Perforator-Based Flap for Repair of Sacral Pressure Sores. Plastic Reconstructive Surgery, 91, 678-683.

[21]   Ahmadzadeh, R., Bergeron, L., Tang, M., et al. (2007) The Superior and Inferior Gluteal Artery Perforator Flaps. Plastic Reconstructive Surgery, 120, 1551-1556.

[22]   Ersoy, E., Devay, A.O., Aktimur, R., et al. (2009) Comparison of the Short-Term Results after Limberg and Karydakis Procedures for Pilonidal Disease: Randomized Prospective Analysis of 100 Patients. Colorectal Disease, 11, 705-710.

[23]   Stauffer, V.K., Luedi, M.M., Kauf, P., et al. (2018) Common Surgical Procedures in Pilonidal Sinus Disease: A Meta-Analysis, Merged Data Analysis, and Comprehensive Study on Recurrence. Scientific Reports, 8, Article No. 3058.

[24]   Mentes, O., Bagci, M., Bilgin, T., Ozgul, O. and Ozdemir, M. (2007) Limberg Flap Procedure for Pilonidal Sinus Disease: Results of 353 Patients. Langenbeck’s Archives of Surgery, 393, 185-189.

[25]   Eryilmaz, R., Sahin, M., Alimoglu, O., et al. (2003) Surgical Treatment of Sacrococcygeal Pilonidal Sinus with the Limberg Transposition Flap. Surgery, 134, 745-749.